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HomeMy WebLinkAboutMiscellaneous - 48 COLGATE DRIVE 4/30/2018 / J 48 COLGATE DRIVE 2101091.0-0018-0000.0 ® The Commerce Insurance Companysm MAPFRE Citation Insurance Companysm 11 Gore Road,Webster,Massachusetts 01570 1 INSURANCE 508.949.1500 www.mapfreinsurance.com January 05,2018 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our Insured: KELLY FRANCIS { Property Address: 48 COLGATE DR Policyk BGBCNB Date of Loss: 01/04/2018 Filek PAVJ72-MWXCY6 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. ESTHER O'NEILL Telephone: (508)949-1500 Ext: 15388 Sr Claim Representative, Property Toll Free: 1-800-221-1605,Ext:15388 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above,by first class mail. January 05, 2018 CIC 254 (Rev.4/95) MAIL M80 14 7 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . ..................k.................../�........................................ ... ..... .... ....d ..... has permission to perfortO?r=..�.7 4d.dt.4.tt................................... .................... plumbing in the b ildings ....................... 7- .......... ....... ..0............................................... North Andover, Mass. at..... &.VA I � Fee..7.9. ..Li No.cj.:.�.,eo... ................................................................................. PLUMBING INSPECTOR Check# w MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY �1�D MA DATE p / { PERMIT# 1/L16-7 i JOBSITE ADDRESS w 10 L C A r iE OWNER'S NAME POWNER ADDRESS L TEL ._ TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:Z REPLACEMENT: Q PLANS SUBMITTED: YES© NO[:]I FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ ( } __.} __„_,-j f _..—_.} } __} _ .} __j . DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM } _..__l —AL-3 DE I DEDICATED GRAY WATER SYSTEM I DEDICATED WATER RECYCLE SYSTEM DISHWASHER -f __._ _( ..___. I _ _.._! ._._..J _ ! _._.__ __ f DRINKING FOUNTAIN _ f ._.__.� ._.--J ._____._► .-.__. f __ _I __..__._.I _._.._._I ___-_} ..__.__1 .__._.. __.._. ____..} _ ___._} FOOD DISPOSER FLOOR/AREA DRAIN -1 ___.._! ___► ____._f _._J _! ____i ____._.� -__.__f ____A_.___ INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ___J __.__.( -___J _.J;= I I ___E tv ROOF DRAIN SHOWER STALL SERVICE/MOP SINK __..__1 ___f _ _.I _._..f .—j TOILET URINAL WASHING MACHINE CONNECTION I f _ ._..._ _ -__-I ._.._..,. WATER HEATER ALL TYPES WATER PIPING I .__-� ! _..__._.J If I i _....-_ _ .._.I _ ___( _ _..f __._ _1 .l I I OTHER I ( f I __....._.} ..___._.( ! 1 f } ! I .__...__I f t '' ►`� -__ _._ ! _.__.. _ _{ ..__.._I ____f ...____J _ ' 1 __-_i ____.} ._. _f .- _j _I __.___! INS _.f ANCE COVERAGE: `. have a current liability insurance policy or its substantial equ' alent which meets the requirements of MGL Ch.142. YES . NO Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE 3Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TY :OF INDEMNITY BOND Q z OWNER'S INSURANCE WAIVER:I am aware that the licensee di s not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this per iit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT J® SIGNATURE OF OWNER OR AGENT e I hereby certify that all of the details and information I have submitted o entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit ssued for this application will be in compliance with all Pertinent provision of the (Massachusetts State Plumbing Code and Chapter 142 of the General L-ws. PLUMBER'S NAME LICENSE# 1 I SIGNATURE Mpg JP DI CORPORATION .. I PARTNERSHIP Q#=LLC� { COMPANY NAME , XdT, P+// 1 aG 1 AC RESS o7 Y i9 B07? �CITYL_I-A LA-/ -- - -f STATE �� ZI TEL i FAX CELL �°d(�..`.,? ._ EMAIL --� ----......_� I �I The Commonwealth of Massachusetts l Department of IndustrialAceldents t~� X Congress Street,Suite 100 , =w F Boston,MA 02114-2017 www mass.gov/dia 7lO�M Sy'v9 Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pluwbers. TO BE FILEDWITH THE PERMITTING AUTHORITY. i A hcant Information Please Print LtOft Name(Business/Organization/Individual): Address: City/State/Zip: Phone Are you an employer?Check the appropriafe box: Type of project(required): 1,u l am a employer with employees(frill and/or part-time).* 7. ❑Nb V d6nstruction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑ ecixical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole "r. proprietors with no employees. 12. iumbing repairs OT additions 5.❑I am a general contractor and Ihave hired the sub-contractors listed on the attached sheet. 1g,0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14. Other ation and its,officers have exercised their right of exemption per MGL c. 6.Q We are a corpor 152,§1(4),and we have no employees.[No workers'comp.insurance required.] zAuy applicant that check's box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. i jiome wn that check this Box must attached an additional sheet showing the name of the sub-contractors and state whether or not those pntiges,have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. , X am an employer that is providing workers I compensation insurance for my employees. below is the policy and job site information. Insurance Company Name: ��✓ Expiration Date Policy#or Self-ins.Lic.#: �� C.v L C A 7 E ,� ' City/State/Zip: AA j " Job Site Address: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fnie up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator.A copy of this statement may be forwarded to the Office of]'nvestigations of the DTA for insurance coverage verification. X do hereby certify under t1lepains and penalties ofperjury that the information provided above is true and correct. Date: )® Si afore: Phone# —n--�� Official use only. Do not write in this area,to he completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk d.Electrical Inspector 5.Plumbing Inspector [.Other Contact Person, Phone#: i i I COMMONWEALTH OF MASSACHUSETTS ...:. t' ■ • • - • • BOARS):OF PLUMB 'D GAS:F.ITtS ' ISSUES. HE T FOLLOW ING`>;; :I:;CENS L t`GENSED AS ..A A MASTER LUh�B R I y � F K1;RitY D MART I N ....... ` t :. 61 CUR- f ER ST r:,,; ��'� , W MA b 1844 26o3 1:;6>=<: 228 81 ,o:.COMMONWEALTH OF MAUSETTS ■ • • 1.1019 • , PLUMBERS` AN'D GASE:.I; T`R: _ _ 1 , I SSUES.;:.THE F0LLOW`I V1 `L I CENSE' REG�SEi ED AS. .A PLUMO�P � P *; r Z I KE.RRY D MART I R.` KERRY D MARTIN; PLB >; HTG' INCA M93 124 ABBOTT STREET LAWRENCE..; 11A 01843 18b 7.?_8164 Date.... .................................... OF NORTH�� TOWN OF NORTH ANDOVER o p PERMIT FOR WIRING ,ssACmu`���� This certifies that ............ ...lLIQ. ,. O has permission to perform ...1 .%, zf Y/�h . .. ......... t' `pp wiring in the building of.... ....................... .e T S ) ................................................... at ................l. .....(<:-ofl. L -.................... . .. . ........., orth over,Mass. Fee..R "' Lic. No. �f, �/ Q /` ELECTRICAL INSPECTOR Check 4t <� ;7� (�✓(?Y a Official Use Only Commonwealth of Massachusetts Permit No. Department of Fire Services ' Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRNT IN)NK OR TYPE ALL INFORMATION) Date: / City or Town of: NORTH ANDOVER To the Inectoiolof Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) C C Owner or Tenant ./ Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes/N No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters aNumber of Feeders and Ampacity JJ Location and Nature of Proposed Electrical Work: k 1 T C-AC,L- ��� /)7 h S261 �ZI . g1a74 Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No,of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires - Swimming Pool Above ❑ In- 171o.o meLighting i rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No, of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection uritNo.of Dryers Heating Appliances KW SecNo.of Systems:* or Equivalent 1 No.of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Te1No of Devices or E u vecommunications alent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCKpen BOND ❑ OTHER ❑ (Specify:) X certify,antler the pains aniesof perjury,that the information on applic to is true and complete. FIRM NAME: . l p / LIC.NO.: Licensee: Signat LIC.NO.:�%�r (If applicable,enter a mpt"in the license numb line Bus.Tel.No.:� Address: O elk Alt.Tel.No.: 2 2 i *Per M.G.L c. 1 7,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent: Owner/Agent I Signature Telephone No. PERMIT FEE.$ ��� y� The Commonwealth of Massachusetts Department of IndustrialAccidents X Congress Street,Suite 100 Boston,MA.02114-2017 www mass.gov/dia VPorkers,Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMCTTZNG AUTHORI'X Y please Print Le 'bl A icant Information // - JJ ) R Jp', Govr)fe Name(Business/Orgariization/Individual Address: © _ Ci /State/Zip: ^��5 . �� G R , , tYz•.., Are yon an employer?Check the appropriate box: Type O project(required); em to 'es full and/or part-time).' 7. ❑N&W'construdtion 1 k I am a employer with___�-_ P y 2-0 I am a sole proprietor or partnership and have no employees working for me in 8, kemo deliiig any capacity.[No workers'comp.insurance required.] x 9,[Demolition 3.[]I am a homeowner doing all work myself[No workers'comp.insurance required.] 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical reor additions ensure that all contractors either have workers'compensation insurance or are sole paurs ,,: proprietors with no employees. 12.Q Ptulnbng repairs or additions 5.F1 I am a general contractpr and I have hired the sub-contractors listed on the attached sheet. 13•, Roof repairs These sub-contractors have employees and have workers'comp.insurance 14.0 Other 6.Fj We are a corporation and ifs,officers have exercised their right of exemption per MGL c. ce required.] o ees. o workers'comp.insuran 152,§1(4),and'we have no empl y , [N . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. t -lomectors that cheek"box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities,have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is pro vidingworkers'compensation insurance for my employees. .Below is the policy and job site information. / Insurance Company Name: T an/_ r c /7 lP ✓t' S I _ � ��O � � a Policy#or Self-ins.Lic.#:_ _ �JrlZf 0 `� '�" Q City/State/Zip: ,rob Site Address: ��/� ��P ' licy declaration page(showing the policy number and expiration ate). Attach a copy of the workers, compensation po ation punishable by a Pirie up to$1,500.00 Failure to secure coverage as required under MGI,c.152,§25A is a criminal viol and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a 'day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do her ehy cer'ti er•the penalties ofperjury that the information provided above's true nd correct. .- Date: 1 'Si ature: Phone#: official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• � Contact Person: f SROM OF MISS. w�LTN ° '' S THE y MAN E `E E LA�p ST .. ,� ola'h� 261 39232 0113 Ar -AA c t . USETTSy _ �F MA' ► HEALTH OF M • • s��R 1ANS A Y E .< o�1 Np �,�G;EN' THE ,F oLL c ISSUES FRED MASTER : z -AVO 1 E THAM p1844_26 MA 39231 - - �6 NUFN o 3 :. 11 648 , i ® The Commerce Insurance Company1m MAPFRE Citation Insurance Companysm 11 Gore Road,Webster,Massachusetts 01570 INSURANCE 508.949.1500www.mapfreinsurance.com February 16, 2016 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our Insured: KEL-LY-FRANCIS/-PETER LUCIA Property Address: 48 COLGATE DR Policy#: BGBCNB Date of Loss: 02/15/2016 Filek MAWX90-JTXXJ3 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number,date of loss, and file number on any correspondence. KEITH FITZGIBBONS Telephone: (508)949-1500 Ext: 15712 Sr Claim Representative,Property Toll Free: 1-800-221-1605,Ext:15712 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above,by first class mail. February 16, 2016 I CIC 254 Rev.4/95 MAIL V10 I , Date.......&1..!. �................ OF NOR7M,� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ,SSACMus�t� thiscertifies that .. .............. ...................... ................................... Chas permission for gas insta ationS.QYTY'., 1<<# �-...a-' ....... inthe buildings of.................................................................................................................. at..../�.y..:��.�....�.. . ..................... .......... PINSPECTO hAndover, Mass. Fee MAW...�Lic. No. .. ...• ! . ........ .............................. GA Check#8.1a / � l: v 'i ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CIT1( MA DATE _ r� t t s PERMIT# (�! JOBSITE ADDRESS $ Cot-L-termer Da,_ OWNER'S NAME �� S"C <J OWNEtADDRESS PRRIIOT OCCUPANCY TYPE COMMERCIAL ]. - EDUCATIONAL.® RESIDENTIAL,, . CLEARLY NEW:[j RENOVATION:[] REPLACEMENT: PLANS SUBMITTED: YES N0[] APPLIANCES Y FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER - - - - CONVERSION BURNER COOK STOVE - - -- - - DIRECT VENT HEA - - — - TER DRYER FIREPLACE, - FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER - LABORATORY COCKS _ MAKEUP AIR UNIT OVEN POOL HEATER ROOM/.SPACE HEATER ROOF TOP UNIT - — - — - - - - —.TEST -- - UNIT HEATER UNVENTED ROOM HEATER - — - -- WATER HEATER _ - - -- 1!. OTHER � - -- - --- — - — - - 6914466 4w&•rtp ovr - - - -- --- - ---- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equhralent which meets the requirements of MGL Ch.142 YES ®NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY© BOND Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage requires by Chapter 942 of the , Massachusetts General Laws,and that my signature on this permit application waives this requirement CHECK ONE ONLY: OWNER Q AGENT SIGNATURE OF OWNER OR AGENT I hereby ow*that all of the details and information I have submitted or entered regarding this application are true and accurate t4the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application wnll be in compliance P Massachusetts State Plumbing Code and Chapter 142 of the General taws. provision of the PLUMBER-GASFITTER NAME ' C07r _ 'C2 LICENSE# ZU�2 SIGNATUp MP MGF[:1 JP Q JGF® LPGI® CORPORATION®#�PARTNERSkIPQ# LLC[:]# � COMPANYNAME:FMe-f,� c�2t2 VwES — ADDRESS X03 CLaKT6N S-C CITY STATE Y'�� ZIP TEL FAX CELL EMAIL Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Brenda & Gerard St. Cyr Property Address: . ' 48 Colgate Drive 1 Policy Number: H012319375 Date/Cause of Loss: 5/7/2012, Rot Damage to Home File or Claim Number: 26239-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Ryan Werner On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. SigK ure and Date ANDERSON ADJY TMENT CO., INC. 50 Nashua !J"dad, Suite 303 PO x 1098 Londond rry, NH 03053 PERMIT No. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 t MAP KBO. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK :PAGE ZONE SUB DIV. LOT NO. �I _ I LOCATION �� / �t A "f-�• PURPOSE OF BUILDING OWNER'S NAME ��//�� rr l•(.A--T f �+ NO. OF STORIES S �� •7/� �� o tcw(�� �/ C 1 SIZE �— OWNER'S ADDRESS /j �.'r'-Q BASEMENT OR SLAB ARCHITECTS NAME ..� SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAME Oa ('�Gy•l„I�" S pe2.e?�� /�/ SPAN i DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS ' DISTANCE FROM STREET 4� t� n POSTS DISTANCE FROM LOT LINES - SIDES O REAR GIRDERS AREA OF LOT 40oo � FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW K J SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY - l' IS BUILDING ALTERATION yt � ,^,nom IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION SEE BOTH SIDES LAND COST EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE.2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS - PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR - DATE FILED SI TC1 E O WNER R AUT ORIZED AGENT ■UILDING INSPECTOR F E E OWNER TEL.# 1/0� PERMIT GRANTED CONTR. CONTR.LIC.# H.I.C.# i I a I /��SN60 oEc,� 1 V V � 5 �V VJ o p �o t v 2/vE 1 .�/E.t'EBY CE.PT/FY TO TyE 7-/TLE/NSU.PO.P ANO �L D T /� C..fi TO THE BA.VY T.S�gT TyE 0i►'EGG/v6 /S LOCATE-O OA/ Tf/E GOT.fs S/,f0/YIv 4AIO TWAT/T GOES CO 11--aP ,Y/T/! T�4/Eraui✓ OFjVO/�✓Oo�ECZON/,vG /N S FU�TiYEP DEPT/FY T//.9T TiY/S O/YELL/N6 /S 4/07- M/ /OT// Tile FEOEPAG F�000 ,y9ZAP0 APES. O�Pi9�1�/V FO.P / �Syawn!oiV F M..( C TEP B7-10,VE".t/Gic/EE•P/,f/6 AT/O•(/ TA.�E.S/ .�,e�or� �'.P7�s'j'7,uc ,Pe-co,Pos. 6� �-4•P,(� :ST,PEE"T ,, w NORT . .Tovm of t over No. 34 Z _ * dower 'Mass. � 19�l _ - O - IANE w 000NICNEW CN A. r a - fG BOARD OF HEALTH } t PERMIT TFood/Kitchen i , Septic System n BUILDING INSPECTOR THIS CERTIFIES THAT 4�. 0�� ............................. . ... ........................... ............................... .............. Foundation ............................... t has permission to erect............?.c� `�� 7Rough to be occupied as ...............po a... ...................................................................... Chimney p ......................................................... .. j provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STA_ ELECTRICAL INSPECTOR A Rough ......... ......... Service r BUIL G INSPECTOR } Final Ii OCC1.lparwy Permit Required t0 Occupy Building GAS INSPECTORRough � I Display in a Conspicuous Place on the Premises — Do Not Remove Final i No Lathing or Dry Wall To Be Done r y. Until Inspected and Approved by the Building Inspector. _ FIRE DEPARTMENT — Burner -street No. - • '" Smoke Det. Location No. Date NORT1q TOWN OF NORTH ANDOVER O Certificate of Occupancy $ Building/Frame Permit Fee $ ' �- ��s''" Fou Other Permit Fee $ s�CHust Other Permit Fee $ RECEIVED AAS nection Fee $ Water Connection Fee $ f JUL p )JPlL $ No,Andover Collector Building Inspector Div. Public Works PER'lmr NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. (, AGE 1 MAP K40. LOT NO. j Q 2 RECORD OF OWNERSHIP 9602f P AG 150, ZONE I SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING �./ OWNER'S NAME -t NO. OF STORIES'rr IZ of 014- T P OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAME _ Q SPANf'7--- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET /OD POSTS DISTANCE FROM LOT LINES-61DES.�/� /..�� REAR k "" GIRDERS AREA OF LOT /� K 1 7 tL�1 FRONTAG'�w�lUYY� ,,� HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW s n10 SIZE OF FOOTING 3 X / .IS BUILDING ADDITIONMATER:AL OF CHIMNEY IS BUILDING ALTERATION O IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY •�� IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LI INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE I FILL OUT SECTIONS I - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 V EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BEEFFILED AND APPROVED BY BUILDING INSPECTOR DATE FILED_ /`/Z`J r BOARD OF HEALTH SIGNATURE OF OWNER OR T ORIZED AGENT F E E e DOWNER TEL N D CONTR.TEL H , PLANNING BOARD PERMIT GRANTED CONTR. LIC.#. BOARD OF SELECTMEN r BU INO INSPECTOR • - 1I I BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S-ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE _ BRICK OR STONE HAR —_ —— PIERS I PLASTERTER ' _ DRY WALL UNFIN. i� 3 BASEMENT AREA FULL I FIN. B'M'TAREA _ '/. 1/1 1/1 FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDV✓'D ASBESTOS SIDING _ COMAACN _ VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON 'MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR 8 GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING _, _ WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. - TIMBER BMS. &COLS. STEAM - STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING r i i 1 OA- e �� Aorw cr" V i S i I ! j f f i wu+p Z l i Mss r ]� -------------------- I 1 - I Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE49a2 JOB LOCATION � CL�L Number " S eet Address Section of town "HOMEOWNER"�0_-pk44j�,,_Ati 6 g 3 - 3 J . 6 N e Home Phone Work Phone ' PRESENT MAILING ADDRESS iOQ' CyJ ,2D City/Town State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license , provided that the owner acts as supervisor. (State Building Code , Section 109. 1 . 1 ) DEFINITION OF HOMEOWNER: Person(s ) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be, a one to six family dwell- ing , attached or detached structures accessory to such use and/or, farm structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding Official , that he/she shall be responsible for all such work performed under the buildingpermit .p (Section 109 . 1 . 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes , by-laws , rules and regulations . The undersigned "homeowner" certifies that he/she understands the ;Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements . HOMEOWNER' S SIGNATURE a2 APPROVAL OF BUILDING OFFICIAL Note : Three family dwellings 35 , 000 cubic feet , or larger , will be required to comply with State Building Code Section 127 . 0 , Construction Control . PLANNING FINAL S FE 1,41 Ef WATVrEC®N S E RVATo®N Town of 0 n over �+� � ��" ENTRY PERMIT ISM!7' ..�.._.__..�.__ . �` - _ ----� ��� � )RIVE%'V t ESN T - 1 19'�, A - Eer, Mass., aff WICK pR QEL BOARD OF HEALTH PERMIT T LD THIS CERTIFIES THAT f jAf# jt 1eq*,*W9 W00%0#6.. ./r/. .Q BUILDING INSPECTOR has permission to erect ......................... n .....PAPA it Is Rough Chimney tobe occupied as........Vg..�•�• •� ... .*................................ Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTION STARTS Service + •• •• •� Final • • BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous-Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. �- yf Building Inspector